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Please fill in the on-line registration form and submit it to us. This will hold your place for 7 days.
To confirm your reservation, please print this form, complete it (please do not forget to sign it) and mail it to us. If paying by check, please include it with this form.
If you have any further questions, please e-mail us directly.
Thanks.
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First Name:
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Last Name:
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Address:
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Apartment #:
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City:
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State/ Province:
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ZIP/ Postal Code:
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- |
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Country:
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Home Phone:
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()- |
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Work Phone:
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()- |
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Cell/Mobile Phone:
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()- |
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Fax Phone:
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()- |
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E-Mail (home):
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E-Mail: (work):
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Sex:
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Age:
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Birthday (optional):
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Smoker:
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Emergency Contact:
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Name:
Relationship:
Phone: ()-
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Hotel:
(choose one)
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Where did you hear
about this trip?
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CANCELLATION CHARGES
Cancellation charges are $400 from February 17, 2010 to March 30, 2010. From March 31, 2010 the total cost of the trip is non-refundable. Cancellation charges are regardless of circumstances. Therefore, we strongly recommend that you purchase travel insurance.
This application must be accompanied by a $400 deposit ($100 non-refundable). Balance is due on February 17, 2010. If paying by check, please make check payable to Jewish Singles Vacations.
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DEPOSIT PAYMENT
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| Payment Type: |
Personal Check AMEX |
| Amount: |
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| Credit Card Number: |
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| Expiration Date: |
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If paying by credit card, your credit card will be charged
when we receive your application.
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BALANCE PAYMENT
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| Payment Type: |
Personal Check AMEX |
| Amount: |
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| Credit Card Number: |
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| Expiration Date: |
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If paying by credit card, your credit card will be charged on February 17, 2010.
If you register for this trip after February 17, 2010,
your credit card will be charged full payment when we receive your application.
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| When sending this form, please sign and date: |
| Signature: |
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| Date: |
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Make checks payable to Jewish Singles Vacations
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